Breakouts start when oil and dead skin cells block a pore, and bacteria and inflammation turn that plug into a pimple, with hormones setting how much oil you make. A gentle routine with a BHA or niacinamide step and a non-greasy SPF suits blemish-prone skin, while the options with the strongest evidence (benzoyl peroxide, adapalene and azelaic acid) are pharmacy products worth asking your pharmacist about; give any routine 2 to 3 months.
Acne starts in the hair follicle and its oil gland. A build-up of dead skin cells and oil blocks the opening, forming blackheads and whiteheads; bacteria growing in the blocked pore then cause inflammation, which shows as red papules, pustules or, deeper down, painful nodules [1][2].
Hormones set the oil level. Androgen hormones can increase oil production, and stress, family history, some medicines and being overweight can also contribute [1]. Acne is not caused by poor hygiene, and food is not a common cause, according to healthdirect [1].
Products and habits can add to it. Greasy hair products can plug follicles along the hairline, and healthdirect advises avoiding oil-based makeup and greasy sunscreen, harsh soaps and over-washing [1][2]. A move from dry to humid weather can also flare breakouts, according to a Victorian dermatologist [15].
Breakouts can leave marks. Dark marks after spots (post-inflammatory hyperpigmentation) and scarring are the main complications, which is why picking is worth resisting and why severe acne is worth treating early [1][2].
When to see a doctor
Breakouts are deep, painful lumps or cysts, or are leaving scars or dark marks [1][2].Acne upsets you or affects your mood, or makes you avoid people [6].You've used a pharmacy treatment for 12 weeks or more without improvement [6].Your GP can prescribe stronger options and refer severe acne to a dermatologist; isotretinoin is prescribed by dermatologists and must not be used in pregnancy [6].Itchy, same-sized bumps on the chest, back or hairline with no blackheads may be fungal acne, which needs a different approach [16].Ask your pharmacist about adapalene 0.1% (Pharmacist Only), benzoyl peroxide and azelaic acid; they will check it is acne and not a lookalike such as rosacea [7][8].
Yes. Adapalene 0.1% for acne has been a Pharmacist Only medicine since 1 June 2021, for adults and children over 12, after a chat with the pharmacist [7][18]. Tell them if you're pregnant or planning to be. Some older health pages still describe it as prescription only.
General information only, not medical advice.